Tonight -11/27/2018- 8pm est THE DOCTOR’S CORNER w/ DR. KLINE & JONELLE ELGAWAY

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Tonight -11/27/2018- 8pm est
THE DOCTOR’S CORNER w/
DR. KLINE & JONELLE ELGAWAY

Topic: How to deal w/ your illness w/out pain meds and questions from the audience.

Tune in on www.cawnation.com and click “Listen.”
OR
YouTube Channel: THE DOCTOR’S CORNER.
Direct link: https://www.youtube.com/channel/UCQk7ewfPvTfo3pleSzvth7A

Call in w/ questions (415) 915-2291

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#TDCwithDrKline

Anthem among health insurers refusing to pay ER bills, doctors say

https://www.cbsnews.com/news/anthem-among-health-insurers-refusing-to-pay-er-bills-doctors-say/

On Aug., 1, 2017, Brittany Cloyd of Frankfort, Kentucky, said she experienced pain “worse than childbirth.” Her mother — who had been to nursing school — drove her to the nearest emergency room. Brittany thought her appendix had burst, but tests at the ER found she had ovarian cysts. She was given pain medication and told to follow up with her primary doctor.

Cloyd had an Anthem Blue Cross PPO health insurance plan and thought she would get charged just a co-pay for her ER visit. Instead, 15 days later she received a letter from health insurer Anthem. “Your condition does not meet the definition of emergency,” read the letter. She was responsible for the total ER bill — $12,596.

What Brittany endured is becoming more common in the health insurance industry, according to a Doctor Patient Rights Project (DPRP) study. It highlighted Anthem, which through its affiliated networks is the nation’s largest private health insurer. The DPRP contends that Anthem has instituted an organized policy of denial designed to make its subscribers — particularly those who are poor and reside in rural areas — too afraid to go to an ER for fear of receiving a bill like Cloyd’s, or more, for the visit.

“The purpose of this program is to spread fear,” said Dr. Ryan Stanton, a critical care and emergency medical specialist in Lexington, Kentucky.

Anthem spokesperson Joyzelle Davis, who said she hadn’t seen the study yet, issued an all-purpose response. “Anthem’s Emergency Department Review aims to encourage consumers to receive care in the most appropriate setting,” Davis said. “Anthem’s review [of claims] aims to reduce the trend in recent years of inappropriate use of emergency departments for non-emergency use.”

Anthem did not provide specific guidelines for what would be an appropriate visit to an emergency room. But in a letter addressed to companies insured by Anthem and obtained by the DPRP, the insurer made it clear that it didn’t want individuals insured by its policies to seek “care right away” at an ER when they could just as easily be treated at a doctor’s office or retail health clinic.

According to Anthem, more than a quarter of its subscribers’ emergency room visits could be treated elsewhere. “If we could reduce unneeded ER visits, we can cut health care costs by $4.4 billion a year,” the letter said. Consequently, Anthem noted, that would cut its member companies’ costs by more than a billion dollars.

“Controversial and dangerous”

Kentucky isn’t the only state where Anthem is rolling out this policy. It’s spreading across the South and Midwest, also. In Georgia, the American College of Emergency Physicians and the Medical Association of Georgia have filed suit in federal court to get Anthem to “rescind its controversial and dangerous … policy that retroactively denies coverage for emergency patients.”

Sen. Claire McCaskill, D-Missouri, sent a letter to both the U.S. Department of Health and Human Services and the Department of Labor asking them to look into whether certain health insurers had violated the “Prudent Layperson Standard” by denying claims. McCaskill is leaving office in January, and her staff did not respond to questions about whether her letter had been answered.

But her question goes to the heart of the matter. Congress enacted the Prudent Layperson Standard for Medicare and Medicaid managed care plans in 1997 and included group and individual health insurance plans in 2010. It defines an “emergency condition” as one in which the average person’s knowledge of health and medicine would dictate that you could go to the ER for treatment of acute symptoms of sufficient severity.

Do you have the ability to diagnose your own pain or injury, and if so, what do you do about it? If you go to the ER, will your insurer deny your claim, leaving you in economic peril? “Patients should never be in the position of correctly diagnosing their … emergency” before seeking help, McCaskill said in her letter.

137 million ER visits annually

But that puts millions of Americans in a vise. In an average year, nearly one in five people report going to the ER, according to the DPRP, for a total of 137 million visits. Doctors, patients and insurers note that statistics from 2012 indicating the average cost of an ER visit, at $1,233, is outdated. One reason for the surge in price since then, according to a University of Maryland study: the increased number of substance abuse cases — particularly among young and middle-aged adults — that now pass through an ER.

Anthem said even a small savings could benefit the health care system, in which Americans spent nearly $3 trillion dollars in 2015. The percentage of patients who leave the ER with no treatment whatsoever is 5 percent according to Anthem, while the Centers for Disease Control and Prevention (CDC) said it’s at least 3.3 percent. Some of these may be psychiatric patients.

But CDC data also appears to show that going to the ER might be the right choice for a serious condition such as chest or stomach pain and high fever. It said 43 percent of all ER cases lead to hospital admissions.

Critics said Anthem will likely keep pushing its policy of denying ER treatment unless it’s stopped. “Anthem is the big boy on the block, but other health insurers are picking up on it,” said Dr. Stanton. “They’re like a child getting into daddy’s wallet. They take a few dollars at a time and, if they don’t get caught, keep going.”

How to file an appeal

Those who feel they’ve been wronged can always appeal. “Patients should first appeal to the insurer,” said Executive Director Stacey Worthy of the Aimed Alliance, a health care coalition dedicated to innovation in medicine. If you get a written denial explaining the reason, then submit documentation and justification for the necessity of the ER treatment.

If you get a second denial, request an external review by an independent party, possibly a state insurance regulator, or someone it appoints. Worthy said it’s labor-intensive for the patient “because the insurer wants you to give up during the process.”

But it often doesn’t get that far, patient advocates said. The Affordable Care Act makes it clear that ER patients have the law on their side, if they can prove a true emergency. “Insurers can’t require you to get prior approval,” the ACA states. And a 2016 study found that 52 percent of retroactive denials were ultimately overturned after independent review.

Brittany Cloyd lost her first appeal, but she refused to take no for an answer. So she sent Anthem a second appeal with documentation and a rebuke.

“I’m not sure how one knows if they’re bleeding internally,” she wrote. “But I hope that it’s apparent … perpetuating scare tactics could certainly convince patients not to go the emergency room. I foresee an onslaught of wrongful death suits in Anthem’s future.”

Cloyd said Anthem then paid her entire $12,596 ER bill.

 

CMS FINAL CALL RULES ON OPIOID PRESCRIBING | EVERYTHING YOU NEED TO KNOW

https://youtu.be/lGfQ1YJ4-TM

What the hell is wrong with wanting to feel PAIN FREE ?

We are suppose to live in a country where our Founding Fathers guaranteed us life… LIBERTY.. and PURSUIT OF HAPPINESS…  Who believes that our Founding Fathers perceived that the bureaucracy that they were creating would be controlled by fellow citizens who would be defining just what our individual  “liberty” and “happiness” entailed ?

Our Founding Fathers also gave us the First Amendment that included “freedom of speech” but they did not guarantee that there would not be some sort of consequences for utilizing your rights under the First Amendment.

Pain is a subjective feeling.. it can be either mental or physical or a combination of the two.

Hunger is a feeling… but … does anyone have the right to tell anyone that they must feel a certain degree of hunger or specific hours during the day ?

If you feel hungry outside of normal meal times.. you experience “break thru hunger” and you resolve it with a SNACK –

Thirst is a feeling … but…  does anyone have the right to tell anyone that they must feel a certain degree of being thirsty for specific number of hours during the day ?

If you feel thirsty anytime … you experience “break thru thirst” and you resolve it with getting something to drink

Fatigue/sleepiness  is a feeling … but…. does anyone have the right to tell you that you can only have a certain number of hours of sleep each day/night ?

If you feel tired outside what is considered the normal sleep period  – you experience “break thru fatigue” and if possible, you address it by taking a NAP

We humans have a whole range of feelings/emotions … depression, anxiety, anger, love and on and on … and there is no way to effectively MEASURE the intensity of all of our potential feelings/emotions

There is a lot of talk about getting a new non-addicting pain med… and we have a bunch of non-addicting pain meds… admittedly they may only work for mild-moderate pain… they are collectively referred to as NSAID’s and Acetaminophen and for someone dealing with chronic pain… many people are taking them regularly… some above the recommended dose and everyone is at risk of them causing kidney or liver damage and/or causing a GI bleed… and it is claimed that 15,000 people die from their use of NSAID’s

CMS is suppose to financially “ding” prescribers and pharmacies if they have pts that are not compliant with their medications to treat diabetes, high blood pressure and  cholesterol meds and at the same time they are imposing limits on pain management meds .

It is well documented that under/untreated pain can have adverse complications to comorbidity issues the pt may have, but this valid health data is being ignored by CMS and other Federal agencies as they try to manage the theoretical  opiate crisis.  So… since under/untreated pain can cause Type II diabetes and high blood pressure ..but the last thing that healthcare professionals want to do is to start giving pts additional medications to treat the side effects of treating – or not treating – a pt.  So… CMS is most likely imposing new health issues and their related hospital/doctor/medication costs on to pts – via copays – and our healthcare system… and we wonder why healthcare costs are going up ?

The BOTTOM LINE is we are dealing with a compliance issue with prescribed medication…  If a prescriber tells the pt to take #x doses a day and they take more than what is prescribed… the pt is non-complaint… then either the prescriber has under estimated the number of doses that will get the pt’s pain down to a tolerant level or the pt has some substance abuse mental health issues. Either way, the pt has poor outcomes..

On the other hand if the pt takes less medication than what was prescribed… the pt is non-compliant and if the pt is on Medicare or Medicaid and treating a specific diseases, then CMS is concerned about the bad outcomes for the pt.  The pt may not be taking what is prescribed because of side effects,the cost or some other reason. Again, the pt has poor outcomes.

While the previous and current Surgeon General and the new head of the CDC has stated that substance abuse/addiction is a mental health issue. Shouldn’t we – as a society – be concerned about treating people with mental health diseases or continue to function under the decision of our judicial system in 1917 that opiate addiction is a CRIME and not a DISEASE and throw those into jail/prison for having a mental health issues and all they are trying to do is self-medicate the demons in their head and/or monkey on their back.

What person doesn’t want to feel healthy/normal ? Why are some diseases perceived as not worth treating ? Why are some deaths socially acceptable and others demand action so that no one else dies like that again ?

 

 

 

 

Southwest Florida Journalists Patricia Borns setting up interviews

No automatic alt text available.

 

Operation Starburst is for all Americans to FIGHT BACK against violations to the 5th & 14th Amendments

https://youtu.be/4DjAILJVFCM

Operation Starburst is for all Americans to FIGHT BACK against violations to the 5th & 14th Amendments. If we do not make a stand now, what will be targeted next? Insulin? Only because addicts can use the needles to inject ILLEGAL heroin. Together we will take back that which has been stolen from us — OUR LIVES! Much luv, soft hugs and many prayers! Robert D. Rose Jr. BSW, MEd. USMC Semper Fidelis (423) 794-8241 four.of.hearts@comcast.net

Please share these VIDEOS from the Cato institute far and wide

Fellow Pain Warriors, may I present the explanation of the TRUE cause fueling the OVERDOSE EPIDEMIC……

Please share these VIDEOS from the Cato institute far and wide. Post on ALL policy makers and media sources Facebook & Twitter pages as well as other PAIN GROUPS in order to make this go viral!

https://youtu.be/tyeTq3OXp9A

https://youtu.be/OkTpAc0xLGI

We’re being SILENCED – We have 2 separate “crises” happening:

#1 HEROIN/FENTANYL OVERDOSE EPIDEMIC Addiction Rate ~2% of US Population

#2 UNTREATED PAIN CRISIS DUE TO ALTERED STATISTICS

100+MILLION Americans SUFFER from chronic pain. Chance of addiction: .06%

We all know what’s really fueling the OVERDOSE EPIDEMIC yet legitimate doctors & pain patients are taking the fall for people who CHOOSE to ABUSE illegal drugs.

MILLIONS are SUFFERING for no justifiable reason!
Who will champion our cause?
Why are our VOICES being SILENCED?
Please help us!
#EndPainPatientAbuse #FENTANYLCRISIS #INHUMANE

Will The Feds Ban Your Pain Meds?

What if you were injured and developed severe pain that wouldn’t go away? Would your government let you take the kind of pain medication you need? If federal officials follow the recommendation of a Food and Drug Administration panel, many of the most effective prescription painkillers—including Vicodin, Percocet, and countless generics—would be banned. Scott Gardner says that kind of a move would be “intensely cruel.” “I took Vicodin for three years,” says Gardner. “I needed it. It got me through a very tough period of my life.” The tough period began after a cycling accident shattered the left side of his body. After eight surgeries and countless hours of physical therapy, Gardner’s once active life is now filled with limitations. He suffers from chronic pain that prevents him from sleeping more than a few hours at a time, and yet his pain today is nothing compared to the agonizing days and months following his accident. “When there’s nothing but pain, there’s no reason to live,” says Gardner. “There were times where the only way I could stay sane and civil was because I could take painkillers.” The fear of addiction and abuse already makes many suspicious of pain medication. Media reports about celebrities like Rush Limbaugh or Matthew Perry suggest that it’s common for people to become addicted to medications they once took for legitimate medical conditions. And countless public service announcements remind us of the dangers of prescription drug abuse. Now the old fear of prescription drug abuse takes a new twist. The FDA panel is targeting drugs like Vicodin and Percocet because they contain acetaminophen, a popular painkiller also found in many over-the-counter drugs. Panel members warn that some Americans ingest too much acetaminophen, and overdoses can lead to liver damage, even death. But maybe the FDA panel isn’t putting this threat into context. After all, mundane threats like falling down stairs claim more lives than acetaminophen overdoses. And it turns out the more common fear—that patients will become addicted to prescription drugs—is also overblown. In fact, the barrage of warnings we hear about prescription drugs obscures an important point—people saddled with severe chronic pain need these painkillers. Says Gardner, “I think people who haven’t dealt with pain don’t really know what it’s like.” “Don’t Get Hurt” is written and produced by Ted Balaker, who also hosts. The director of photography is Alex Manning, the field producer is Paul Detrick and the animation in the piece is from Hawk Jensen. Approximately five minutes. Go to Reason.tv for downloadable versions of all videos, more links, and other related materials.

Reach out to this reporter and share THE TRUTH about the proper/appropriate use of opiates in chronic pain

I was contacted by a chronic painer in S Florida and apparently this reporter just regurgitated this article from what she was told by a ER doc…  Apparently, after talking to a local chronic painer she has been “enlightened” to the plight of those in the chronic pain community and perhaps some more positive stories might get generated if those in S Florida reached out to her… Here is her email  pborns@news-press.com

 

Doctors are rethinking pain management – should you?

https://www.news-press.com/story/news/2018/11/20/doctors-rethinking-pain-management-should-you/1897236002/

A uterine cancer diagnosis changed Lyla Whitson’s world several years ago, but the oxycontin prescription that helped manage her pain shattered it.

“When the prescription stopped after my hysterectomy, I went to the doctor thinking I had a bad case of the flu,” said the Cape Coral woman who turned to heroin. “My doctor said, ‘You don’t have the flu. You’ve been taking pain pills for three years.”

But it doesn’t take nearly that long for opioid withdrawal symptoms to set in from pain pill use, said Lee Health Emergency Room Dr. Aron Wohl. 

Some hospital patients report the most common signs – nausea, diarrhea and chills – after three or four days’ use.

“What they are becoming is physically dependent,” Wohl said. “That can lead to addiction if you continue use.”

An alarming number of people do continue. The Centers for Disease Control found 24 percent of people who were given a 12-day supply of opioid pills were still taking the medication a year later. Six percent were still taking them having only been given a one-day supply.  

At the Lee Health ER and across the country, a growing practitioners’ movement wants to prevent dependency before it begins. 

“For the last 15 to 20 years we wanted you to be at pain level 0,” Wohl said. “The pharmaceutical industry promoted and lobbied for that. We do not need to be at 0 pain.”

The overprescription of opioids is leveling off, but deaths continue rising, says Dr. Marc Fishman of the Maryland Treatment Centers. He talks about addiction, treatment and bootleg fentanyl with USA TODAY Editorial Page Editor Bill Sternberg. USA TODAY

The pendulum of pain management is swinging back to techniques like elevation, compression, ice and heat that fell by the wayside decades ago. 

Say you broke an arm or sprained a tendon and it’s acutely painful. Doctors who in the past might have prescribed hydromorphone or oxycodone now say that aspirin or non-steroidal anti-inflammatories like Ibuprofen are best, Wohl said.

Following recommendations of the CDC, a consensus is growing to treat episodes of acute pain with opioids for three days at most.    

“After just five days of prescription opioid use, the likelihood that you’ll develop long-term dependence on these drugs rises steeply,” Mayo Clinic’s new guidelines say. 

Florida healthcare providers adopted three-day limits for opioid prescriptions based on a new definition of acute pain signed into law by Gov. Rick Scott in March. (Pain from cancer or a terminal condition is excluded from that rule.)                

Providers are also expected to come up with recommended pill counts for specific medical procedures that would reduce pill counts dramatically. 

A pioneering group, the Michigan Opioid Prescribing Engagement Network has already published a model prescribing guide

For a hysterectomy like Whitson had, its recommended dose of hydrocodone is 20 to 35 tablets at 5 mg strength, for example. 

For a breast biopsy, 10 tablets. 

Until recently there was no definitive recommended guide for pill counts at all.

“The answer today is Tylenol and Motrin in many cases,” Wohl said. “For a severe injury – a  tibial lower leg fracture, for example – an opioid used sparingly would probably be recommended. The key is sparingly and with understanding of the risk.”

While doctors are becoming more vigilant, consumers have the most to gain by being their own advocates. The good feelings you have on opioid medications are tempting to continue, but they won’t last, Wohl said.  

Just ask Whitson, who lost her home and family and is still on the street seeking drugs to feed her addiction.

Southwest Florida’s Ramona Miller gives opioid users the overdose antidote Narcan for free. “The best person to help an addict is an addict,” she says. Patricia Borns, pborns@news-press.com

What you can do

  • If your doctor prescribes one of the common opioid medications for your pain (below), ask if it’s OK to take Tylenol, Motrin or Advil instead. 
     
  • Don’t keep using opioids when your pain subsides. Wait longer between doses and stop as soon as the pain does.  
     
  • If you stop taking opioids after three to five days, you may feel body aches, nausea, vomiting, diarrhea or constipation. Recognize them as withdrawal symptoms that will pass in one to a few days. Don’t take more opioids to try to feel better.

Pain-free is a pharma myth, Wohl said; an idea seeded by a marketing campaign called Pain is the 5th vital sign, complete with pain scales, that spread through groups such as the Joint Commission and American Pain Society. 

An entire generation was led to believe they should be pain-free.

The re-learning process is just beginning, Wohl said.

Follow this reporter on Twitter @PatriciaBorns.

Colorado Vet’s Death Offers Glimpse Into Suicidal Mind

https://www.facebook.com/lee.cole.1232

Colorado Vet’s Death Offers Glimpse Into Suicidal Mind

https://www.usnews.com/news/best-states/colorado/articles/2018-06-23/colorado-vets-death-offers-glimpse-into-suicidal-mind

Hours after being discharged from a mental health treatment facility, 38-year-old disabled veteran Lee Cole hiked into a wilderness area in southwest Colorado Springs with a backpack and the cellphone on which he planned to record his final message.

By STEPHANIE EARLS, The Gazette

COLORADO SPRINGS, Colo. (AP) — Hours after being discharged from a mental health treatment facility, 38-year-old disabled veteran Lee Cole hiked into a wilderness area in southwest Colorado Springs with a backpack and the cellphone on which he planned to record his final message.

Most of that roughly four-minute Facebook Live video, posted publicly the evening of April 23, shows a wobbly pan around a bramble-choked gully, with only a fleeting careen over Lee’s expressionless face.

Turn up the volume, though, and his pain is achingly clear.

“I’m gonna die tonight,” he says, in a taut and breathless voice, his dark pronouncement backed by a dissonant chorus of birdsong. “I’m going to find the highest cliff here and jump off.”

The video spread quickly among Lee’s Facebook intimates and then beyond, with friends, acquaintances and strangers posting prayers and pleas, and then joining the family to try to pinpoint his last known location.

By the following day, his brother, Clayton Cole, was fielding tips and posting public Facebook updates on the search, and the crusade had expanded to other social media and real world hubs, including the Missing Angels network and message boards for the area’s outdoors community. People who’d never met the Cole family stopped what they were doing to help identify the spot where Lee’s video and last photo were shot, and then organized search parties or set out to look on their own.

It was one of those volunteers who ultimately found him, three days later.

Lee had done what he said he would. He’d found a cliff.

“He called it ‘Christ in the Mountains.’ That is what he jumped towards,” said Clay, gazing at a cellphone image of Lee’s final photo: a rocky outcropping in Cheyenne Canyon, at the far side of a wooded ravine. “He just decided, I guess, that he was done trying to get help.”

From rural farming communities in Montana to high-rises in Manhattan, America is grappling with an epidemic of hopelessness.

Two days after the June 5 suicide of fashion designer Kate Spade, and a day before the suicide of celebrity chef Anthony Bourdain, the Centers for Disease Control and Prevention released an alarming report that showed the nation’s suicide rate increased by 25 percent between 1999 and 2016. Numbers are the highest they’ve been in the three decades since the introduction of new antidepressants began driving rates down in the late 1980s.

The dark trend has cast an especially long shadow over the nation’s veteran population and the mental health safety nets set up to keep them from crisis.

Lee’s death, in particular, shines a spotlight on a category of service members who may be facing an even greater risk of suicide than other vets and the general population — those who have never seen combat.

“Lee worked the Waldo Canyon fire, he worked the Black Forest fire, he worked the floods in 2013. He raised his right hand and pledged to defend his nation and was honorably discharged from the Colorado Army National Guard,” said Clay, whose brother suffered from chronic back pain and PTSD due to a training accident. “He did what his nation asked of him … and he got injured.”

One study of post-9/11 veterans showed that suicide rates and risk also were higher among those whose enlistments were cut short, for administrative, health or other reasons.

Experts theorize the surge may be due to the loss of identity and structure that comes with separation. Clay believes that outside factors play a critical role, as well.

Empathy for America’s service members and what they’ve experienced, he said, can seem conditional.

“The reason you join the military, and especially for my brother, is because you want to serve your country in the capacity of going to war — not I want to go shoot people, but I want to serve in the way my country wants me to serve and Lee did that,” said Clay, a member of the Army Reserve who served 14 years active duty. “It’s difficult for someone who’s been overseas to have someone who hasn’t been overseas say they’ve got PTSD. We’ll say, ‘Well you’ve never been down range, you’ve never seen anything,’ but Lee served his nation the way that his nation asked him to serve … just not in the way he’d planned.”

Since 1999 in Colorado, the heart of the so-called “suicide belt,” the number of people taking their own lives has increased by more than 34 percent.

Higher rates in the American West are likely due to a confluence of several factors, including greater access to firearms and terrain that can make crisis intervention especially challenging.

“If someone’s committed to doing it, there are many, many places for them to do it in El Paso County where it’s very, very difficult to find them,” said El Paso County Sheriff’s Office spokeswoman Jacqueline Kirby, whose office responded to almost 80 “suicidal check the welfare” calls in March.

Nationwide, doctors and public health experts tie escalating cases of self-harm, in part, to the opioid crisis, combined with a changing landscape where more people struggle to access, and afford, primary medical care, much less psychological treatment and counseling.

But even given an ideal scenario, there’s no universal protocol for treating someone who’s in the depths of potentially-lethal despair.

“I have battled with suicidal thoughts — I think my whole family has. My grandfather committed suicide, my uncle committed suicide … and now my brother,” Clay Cole said. “I know I’m at extremely high risk because of my family makeup, but if I don’t recognize that and don’t talk about it … I don’t know how to deal with those types of feelings.”

For Lee, though, talking about those feelings wasn’t enough. A three-day inpatient stay at Cedar Springs, the weekend before his death, wasn’t the first time he’d been in treatment — voluntary and non — nor was his trip to the woods the first time he’d tried to end his life.

“Lee had his struggles, with alcohol, drugs, mental health, for 20 years … but he was a good kid. He had a lot of good friends and family that cared about him – driving him to appointments, taking him in and giving him a place to live, but then he’d turn around and break the rules,” said Lee’s father, William Cole, who lives in Florida. “But it’s a fine line between knowing when to help and when not to help. That’s one of the struggles I went through … and I’m still going through it.”

According to the CDC, more than half of those who committed suicide since 1999 had no known history of mental health issues.

Lee Cole was not among that demographic. He was, however, within the purview of other troubling subsets.

The suicide rate among Colorado veterans was nearly double the state’s overall rate, with vets at a 19 percent higher risk of suicide than civilians, according to a first-of-its kind analysis by the VA of more than 55 million veteran records from 1979 through 2014.

Earlier this year, a congressionally-ordered review of veterans’ mental health care access by the nonprofit National Academies of Sciences, Engineering and Medicine revealed that approximately half of the 4 million people who’d served since 9/11 weren’t getting the treatment they needed from the VA for issues such as PTSD, substance abuse and depression.

“So many veterans need our services, especially in this community,” said Duane France, a retired Army noncommissioned officer, combat veteran and clinical mental health counselor in Colorado Springs, a city that’s home to one of the nation’s largest concentrations of active and former military. “The VA has great clinicians, but they’re overwhelmed.”

France has proposed a new “Green Alert” bill that, if taken up and adopted by state legislators, would establish a system similar to the Amber or Silver alerts enlisting the public’s help in locating missing, at-risk veterans.

Expanding the search bandwidth could save lives in such a scenario, but — perhaps more importantly — France said he hopes the proposal will spark a conversation that reaches the right ears.

“There are so many great resources here in the Springs, but too many people aren’t aware of them or able to access them,” he said. “We always say, ‘A veteran doesn’t need a good reason to avoid therapy.'”

A star athlete as a teen, Lee began struggling with his demons after high school and gave up driving, but not the drink, after a DUI. As 30 loomed, though, he seemed dedicated to getting his life on track, and believed enlisting in the Colorado National Guard was the way to do it, said his dad.

The National Guard is a part-time reserve military force, but members undergo the same rigorous training as Army enlistees.

That period was a “really bright one” for Lee, said Bill Cole, a retired Chief Master Sergeant who served 30 years in the Air Force. “He just loved it and did really good in basic and technical school. But when they handed him over to the National Guard, and it was no longer 24/7 and just one weekend a month. … That was always one of my biggest fears, because Lee kind of needed someone looking over him all the time.”

During a training exercise in Wyoming, the Humvee Lee was in crashed and rolled several times. The injuries to his spine were profound.

“He couldn’t walk; he was in constant pain,” Clay said.

The scars on Lee’s psyche weren’t as easy to see.

Clay believes “100 percent” that the accident led to PTSD that exacerbated Lee’s depression and locked him in a cycle of pain and addiction, ultimately with no end in sight.

“He was always trying to get some relief. So what does the VA do? They write him a prescription for 90 days of opiates … a guy with a history of substance abuse problems,” he said. “From what my brother told me, surgery was on the horizon … but it had been for a while. When the VA doesn’t move quickly on things like this, it gives a person who is in so much pain a reason to go back to abusing their medications.”

Even accounting for the greater severity of pain likely being suffered by those on higher doses, and the fact that they weren’t more likely than any other group to die by overdose, a VA study last year found that veterans who received the highest doses of opioid painkillers were more than twice as likely to die by suicide when compared to those being treated with the lowest doses.

Opioids work by tricking the brain’s neural network into triggering feelings of euphoria via a mega-dose of dopamine. Prolonged — and even short-term — use not only can lead to dependence but an erosion of the brain’s natural ability to tolerate pain and process feelings of joy.

In short, opioids present the kind of biological foil that makes depression, and treating it, even more complex.

“I’ve already been through two psych wards in the last four days, and they released me,” says Lee, near the start of his video. “Been off my meds …”

In the end, Clay figures his brother was just trying to control the pain he was feeling, in his body and in his soul, “any way that he could.”

Depression is a “disorder of the mood … mysteriously painful and elusive in the way it becomes known to the self … as to verge close to beyond description,” wrote William Styron, in his groundbreaking 1990 memoir “Darkness Visible.”

Such catastrophic feelings are “nearly incomprehensible” to those who have not experienced them, or only glimpsed them in fleeting, situational bouts with “the blues,” wrote Styron, whose concise work began as an exercise in understanding his own disease and became a treatment tool and flash point for the depression awareness movement.

“The madness of depression is, generally speaking, the antithesis of violence,” Styron wrote. “It is a storm indeed, but a storm of murk.”

Colorado National Guard Chaplain David Nagel understands the destructive power of that storm. It used to cost him sleep, thinking about all the veterans in distress and going it alone. But “good safeguards” developed in the last decade, to identify and assist those who are struggling before they’re in crisis, have helped, he said.

Those safeguards include the establishment of “gatekeepers” in each National Guard unit who receive specialized training in intervention and suicide prevention, as well as how to spot the warning signs.

“If someone comes forward for help, we want to get them help,” Nagel said. When they don’t, those “‘lifeguards’ can be our additional eyes in each unit.”

“We can’t force people to disclose this stuff, but we strongly can encourage them … and say, we’ve got to get you better,” said Nagel,” one of two full-time support chaplains for the Colorado National Guard. “We take the mental health of each of our service members and their families very seriously. These people really are our greatest treasure. And if we don’t have a healthy force, we’re not able to serve our state and nation when we’re called.”

Tackling that role, from a faith or any perspective, requires an understanding that today’s military is unlike any that served before. Active-duty service members face more deployments, for longer periods, often with too little time back home to re-establish connections or get their bearings.

Whatever Lee’s story, Nagel said he wishes he would have reached out to him before giving up.

“I don’t know if I could have helped. … I know everyone likes to think they could have helped,” he said.

In recent years, Lee had been living with relatives and in and out of sober homes, but seemed to get control of his addictions during a four-month stay at a treatment facility in South Dakota in late 2017. Back in Colorado in January, though, he quickly spiraled back into bad habits and gloom, Clay said.

The day of his return, the brothers went out to lunch in Denver, where Lee had moved back in with their mom.

“He seemed a little off, but I just figured he was integrating,” Clay said.

When he woke up the next morning and saw Facebook photos, posted in the wee hours, of Lee “looking angry and holding a shotgun,” Clay called the police.

“He’s a gentle guy, who’d never, ever hurt anyone. So when I saw those photos … I knew it wasn’t him. It was completely out of character,” said Clay, who arrived at his mother’s house as the police were on their way out. “The last time I saw my brother alive, he was in handcuffs, about to be transported to the mental ward.”

Three months later, Clay logged on to Facebook to find his worst fear playing out, in real time.

Clay said he doesn’t know if Lee could have been saved.

Perhaps with more interventions, more searchers, more love? Or, if someone had been there to meet him when he left Cedar Springs, or the numerous hospitals and facilities, VA and non, that treated him had shared records and been able to work together?

Attempts to contact Cedar Springs to learn more about the facility’s discharge protocol for patients under care for suicidal ideation and depression were unsuccessful.

On a Friday in early June, Clay made his way back to the gully where Lee filmed the video, this time with his mom, Susan Morton Cole.

Susan couldn’t bring herself to watch her younger son’s final message, so it was the first time she’d seen the place where he said goodbye.

After hours of hiking through the woods, Clay said he and his cousins were able to identify the gully, on April 25, and called the sheriff’s department with the update on Lee’s

“It really is beautiful,” said Susan, in a quiet voice, as she overlooked the spot, so similar to all the countless others here.

For a moment, she and Clay let themselves get lost in wistful cheer and memories about a kind-hearted boy who became a kind-hearted man who loved cats, eagles, mischief and his family, even when it might have seemed otherwise. They also talked about the community that helped bring him home.

“If you watch his last video, he said he had nothing and nobody, but that wasn’t true. So many people came together, in such a short period of time, to try to find him,” said Clay. “He had over 150 people at his funeral.”

After the service, more than two dozen of those people met for a less formal memorial, in the gully that now unofficially bears Lee’s name.

Clay can’t help but smile when he looks at the Facebook photo of that gathering.

“It’s really amazing, how people can be,” he said.

He didn’t have the heart to tell them he’s pretty sure they were partying in the wrong place.